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Rapid response to:


Measles: Samoa declares emergency as cases continue to spike worldwide

BMJ 2019; 367 doi: (Published 29 November 2019) Cite this as: BMJ 2019;367:l6767

Rapid Response:

Re: Measles: Samoa declares emergency as cases continue to spike worldwide

In the same way that the Samoa Government’s decision to suspend the national immunisation program from July 2018 to April 2019 following two vaccine-associated paediatric deaths (later found to be due to medical negligence) [1,2] led to a sharp decline in measles-containing vaccine (MCV) coverage among infants in 2018 (first- and second-dose MCV coverage of just 40% and 28%, respectively) [1,3] and laid the foundation on which the current measles crisis was able to develop, health authorities should be concerned that the redirection of health resources to respond to the crisis may – if not managed carefully – have negative impacts on other priority health programs.

In the background of the measles epidemic, the Samoa population faces a non-communicable disease (NCD) tsunami with an estimated 71.2% of the burden of disease, including approximately 880 deaths annually, attributable to cardiovascular diseases, diabetes, cancers and other NCDs [4]. The drawing of clinical and public health resources away from services that aim to treat and reduce the impact of these diseases, even in the short term, runs the risk of stalling the good work that has been done and – inadvertently – resulting in greater associated deaths and disabilities.

The Samoa government faces many challenges in responding to both the acute infectious and underlying chronic epidemics the population faces. When monitoring and evaluating the impact of the measles outbreak on population health the indirect and opportunity costs associated with the response should be realised and accounted for.
Competing interests: No competing interests.

[1] Dyer O. Measles: Samoa declares emergency as cases continue to spike worldwide. BMJ 2019 [cited 2019 Dec 5]; 367:l6767. Available from: URL:
[2] The Immunisation Advisory Centre. Infant deaths in Samoa a tragic outcome from error preparing MMR vaccine; 2019 [cited 2019 Nov 25]. Available from: URL:
[3] World Health Organization. Reported administrative target population, number of doses administered and administrative coverage: data extracted from WHO database. Data for 2000-2018 [Data]; 2019 2019. Available from: URL: [cited 2019 Nov 25].
[4] Institute for Health Metrics and Evaluation (IHME). GBD Compare: IHME, University of Washington; 2019 [cited 2019 Dec 5]. Available from: URL:

Competing interests: No competing interests

05 December 2019
Adam Craig
Lecturer, Global Health
Heather Worth
University of New South Wales (Sydney)
Wallace Wurth Building